5 ways to expand your pediatric pain management repertoire

Everyday, in EDs across the planet, children are poked and prodded. We draw blood, we clean wax out of ears – little things, but they are painful for our patients. Here are a few things that are relatively easy to do, that can reduce the pain we sometimes inflict:

1. Topical numbing agents – like EMLA, or LMX. If you think a kid’s going to get stuck, these can make a difference, especially if you can get the triage nurse to apply it. LMX (4% liposomal lidocaine) only takes 30 minutes. Slap it on at triage, register the kid, take the vitals, do your assessment and by that time it’s probably been at least 30 minutes. When an outside doctor calls to refer a child to the ED, have them put it on before sending the child.

2. Sucrose – sugar water isn’t a drug but it behaves like one in infants. It helps calm them in stressful situations. Try squirting some in the mouth or dipping the pacifier in sucrose before a venous stick or ear wax removal. Keep it handy at the bedside cart. If you have to leave the bedside, write for it and wait until it shows up, you’re less likely to use it.

3. Caregivers – holding a child down on a table to do a blood draw is more traumatic for them than doing it in the parent’s lap. With good positioning, you can frequently get your stick while the parent holds the child.

4. The power of distraction – flashy toys and blowing bubbles are great but you can also do this by having someone stroke the child’s forehead and talk softly to them about good things like birthday parties or family trips. This is a good role for a parent, but any extra person can do this.

5. Swaddling – wrapping a young infant is also soothing. The next time you send one to the CT scanner, try swaddling them and dipping the pacifier in sucrose. You just might get that scan without sedation.

All these modalities are available in most EDs. You just have to remember to use them. Reducing pain is as much about mindset as it is about medication.